| NPI | 1427049451 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: KS 1014) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MO 2005008902) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2007-07-09 |